Employee Illness Monitoring Log

Instructions to Complete

When employees report an illness, complete the information on the attached Employee illness monitoring log. You do not have to use a different page for each day or for each employee. Keep the log stored in the location indicated on the Section 2-6: Monitoring and Record Keeping Summary. Continue to use the page for the entire school year or until it is filled.

Employee Name – Write the name of the employee reporting the illness.

Nature of Illness – Check the type of illness reported by the employee.

Date and Time of Report – Note the date (i.e. 3/14/12) and time (i.e. 6:15 AM) that the employee reports the illness.

Action Taken - Use the illness Guide in Section 2-4 Prerequisite Programs, Appendix A to determine the appropriate action about allowing the employee to work. Check the type of action taken.

Date and Time of Return - Note the date (i.e. 3/16/12) and time (i.e. 7:40 AM) that the employee returns to work.

EMPLOYEE ILLNESS MONITORING LOG

Name of Employee / Nature of Illness / Date and Time of Report / *Action Taken / Date and Time of Return
Diarrhea
Vomiting
Jaundice
Sore throat w/ fever
Infected wounds / No work restrictions
Restricted duties
Excluded from work
Diarrhea
Vomiting
Jaundice
Sore throat w/ fever
Infected wounds / No work restrictions
Restricted duties
Excluded from work
Diarrhea
Vomiting
Jaundice
Sore throat w/ fever
Infected wounds / No work restrictions
Restricted duties
Excluded from work
Diarrhea
Vomiting
Jaundice
Sore throat w/ fever
Infected wounds / No work restrictions
Restricted duties
Excluded from work
Diarrhea
Vomiting
Jaundice
Sore throat w/ fever
Infected wounds / No work restrictions
Restricted duties
Excluded from work
Diarrhea
Vomiting
Jaundice
Sore throat w/ fever
Infected wounds / No work restrictions
Restricted duties
Excluded from work
Diarrhea
Vomiting
Jaundice
Sore throat w/ fever
Infected wounds / No work restrictions
Restricted duties
Excluded from work
Diarrhea
Vomiting
Jaundice
Sore throat w/ fever
Infected wounds / No work restrictions
Restricted duties
Excluded from work
Diarrhea
Vomiting
Jaundice
Sore throat w/ fever
Infected wounds / No work restrictions
Restricted duties
Excluded from work
Diarrhea
Vomiting
Jaundice
Sore throat w/ fever
Infected wounds / No work restrictions
Restricted duties
Excluded from work

*Use the Illness Guide in Section 2-4 Prerequisite Programs, Appendix A to determine the appropriate action.

4/3/2012 CK – 2-6: Monitoring and Record Keeping